Ibuprofen Abuse—A Case of Rhabdomyolysis, Hypokalemia, and Hypophosphatemia With Drug-Induced Mixed Renal Tubular Acidosis

Patil, S. S.; Subramany, Swathi; Patil, Sachin; Gurram, Pooja; Singh, Manisha; Krause, Michelle W.

doi:10.1016/j.ekir.2018.05.014

Cited by 14 publications

(18 citation statements)

References 4 publications

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“…Nurofen Plus misuse has been associated with life threatening hypokalaemia and renal tubular acidosis in a handful of cases 9 10. We describe a patient who unwittingly ingested excessive ibuprofen over a prolonged period of time as a result of opiate dependence from a seemingly innocuous over the counter combination medication.…”

Section: Discussionmentioning

confidence: 97%

Impaired consciousness, hypokalaemia and renal tubular acidosis in sustained Nurofen Plus abuse

Hasan

Armstrong

et al. 2019

BMJ Case Rep

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Ibuprofen-induced renal tubular acidosis is a rare but important diagnosis which should be considered in patients presenting with hypokalaemia and metabolic acidosis. This case report details the case of a 33-year-old woman presenting with reduced conscious state, metabolic acidosis and profound hypokalaemia without an obvious cause. With correction of the patient’s electrolyte and acid-base disturbance, her conscious state improved allowing disclosure of her use of Nurofen Plus for its euphoric opiate effects. The diagnosis of renal tubular acidosis had been considered and subsequent disclosure of excessive chronic ingestion of ibuprofen suggested this to be the underlying cause. The striking feature of our patient was the insidious development of the problem and delayed accurate drug history. An important safety message arising from our case is the composite risk of dependence on the opiate component of over the counter analgesics, such as Nurofen Plus, and adverse events related to the ibuprofen component.

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Section: Discussionmentioning

confidence: 97%

Impaired consciousness, hypokalaemia and renal tubular acidosis in sustained Nurofen Plus abuse

Hasan

Armstrong

et al. 2019

BMJ Case Rep

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“…A PubMed search showed only 16 cases of ibuprofen-induced hypokalemia and RTA as mentioned in Table 2 [1][2][3][4][5][6][7][8][9][10][11][12][13]. The majority of the patients were females (10) The most prominent abnormalities seen in our patients are hypokalemia, metabolic acidosis likely secondary to proximal RTA, with a negative urinary anion gap in patient 1, and distal RTA, with a positive urinary anion gap in patient 2, and alkaline urine pH in the setting of ibuprofen overuse.…”

Section: Discussionmentioning

confidence: 99%

“…Ibuprofen-induced hypokalemia was first described by Gaul et al [1] in 1999, and since then, there have been a total of 16 cases reported per a PubMed search [1][2][3][4][5][6][7][8][9][10][11][12][13]. Interestingly, most cases have been reported from Australia, UK, with one case from Mexico and one from the USA.…”

Section: Introductionmentioning

confidence: 99%

Ibuprofen Overuse Leading to Life-threatening Hypokalemia Associated with Renal Tubular Acidosis in Two Patients

Thammineni

Kathi

Sharma

et al. 2019

Cureus

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Ibuprofen is a commonly used medication in the United States and is used both by prescription and over the counter, while hypokalemia is a life-threatening condition caused by various etiologies, one of which is the side effect of medications. Ibuprofen is well-known for its various nephrotoxic side effects, including hyperkalemia as a common electrolyte abnormality, however, renal tubular acidosis leading to hypokalemia with the use of ibuprofen has been reported rarely. We present here two cases of life-threatening hypokalemia due to over-thecounter use of large doses of ibuprofen and describe its management.

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“…Patil et al. 1 recently reported in this journal a patient with mixed renal tubular acidosis (RTA) after ibuprofen abuse. They suggested that carbonic anhydrase (CA) II inhibition by ibuprofen overdose may have led to RTA in this patient 1 .…”

mentioning

confidence: 99%

“… 1 recently reported in this journal a patient with mixed renal tubular acidosis (RTA) after ibuprofen abuse. They suggested that carbonic anhydrase (CA) II inhibition by ibuprofen overdose may have led to RTA in this patient 1 . More than 16 patients with ibuprofen-induced RTA have been reported1, 2; however, these reports did not discuss the possible mechanisms of CA II inhibition by ibuprofen overdose.…”

mentioning

confidence: 99%

Ibuprofen-Induced Renal Tubular Acidosis

Watanabe

2019

Kidney International Reports

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Ibuprofen Abuse—A Case of Rhabdomyolysis, Hypokalemia, and Hypophosphatemia With Drug-Induced Mixed Renal Tubular Acidosis

Cited by 14 publications

References 4 publications

Impaired consciousness, hypokalaemia and renal tubular acidosis in sustained Nurofen Plus abuse

Impaired consciousness, hypokalaemia and renal tubular acidosis in sustained Nurofen Plus abuse

Ibuprofen Overuse Leading to Life-threatening Hypokalemia Associated with Renal Tubular Acidosis in Two Patients

Ibuprofen-Induced Renal Tubular Acidosis

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